Leonetti G, Cuspidi C, Sampieri L, Ambrosioni E, Malini P L, Pessina A, Semplicini A, Cinotti G, Morabito S, Rappelli A
Institute of Clinica Medica, University of Milan, Italy.
J Hum Hypertens. 1990 Feb;4(1):5-11.
We report the results of a randomized, double-blind, parallel group multicentre study in 120 patients with moderate to severe hypertension, comparing two different types of antihypertensive treatment: a) the standard 'triple therapy' with hydrochlorothiazide, propranolol and hydralazine, and b) the combination of an ACE inhibitor, enalapril with hydrochlorothiazide (HCTZ) and methyldopa. The two regimens caused similar degrees of blood pressure reductions. The only significant difference between the two groups was heart rate due to the bradycardiac effect of propranolol in the group treated with the standard 'triple therapy'. Only 3.4% of patients receiving the regimen of enalapril, HCTZ and methyldopa were withdrawn from the study for adverse reactions, against 10% of patients on HCTZ, propranolol and hydralazine. Four cases of hypokalaemia in the enalapril group and 19 in the propranolol group were reported: so enalapril seemed to ameliorate the hypokalaemic effect of HCTZ. The overall analysis of the study results shows that the treatment based on enalapril, HCTZ and methyldopa is as efficient and better tolerated than the established regimen of HCTZ, propranolol and hydralazine.
我们报告了一项针对120例中重度高血压患者的随机、双盲、平行组多中心研究结果，该研究比较了两种不同类型的抗高血压治疗方法：a）采用氢氯噻嗪、普萘洛尔和肼屈嗪的标准“三联疗法”；b）血管紧张素转换酶（ACE）抑制剂依那普利与氢氯噻嗪（HCTZ）和甲基多巴的联合使用。两种治疗方案导致的血压降低程度相似。两组之间唯一显著的差异在于心率，这是由于标准“三联疗法”治疗组中普萘洛尔的致心动过缓作用。接受依那普利、HCTZ和甲基多巴治疗方案的患者中，仅有3.4%因不良反应退出研究，而接受氢氯噻嗪、普萘洛尔和肼屈嗪治疗的患者中有10%退出。依那普利组报告了4例低钾血症，普萘洛尔组报告了19例：因此依那普利似乎改善了氢氯噻嗪的低钾血症效应。对研究结果的总体分析表明，基于依那普利、HCTZ和甲基多巴的治疗与既定的氢氯噻嗪、普萘洛尔和肼屈嗪治疗方案一样有效，且耐受性更好。
